geoffrey modest medical blogs

A recent systematic review looked at articles on patient inhaler technique over the past 40 years, finding that 1/3 of users had poor technique, and that number has not changed over these 4 decades (see  asthma inhaler errors chest2016  in dropbox, or Sanchis J. Chest 2016; 150(2): 394). details: --144 articles from 1975-2014 reported on  54,354 subjects performing 59,584 observed tests of technique, from 31 countries around the world --54 studies reported on asthma, 14 on COPD, and 76 on both or unspecified. --mean age of adults was 54, and of children was 9. --results for  most frequent errors :     --metered-dose inhalers (MDI): problems with full expiration in 48%, coordination 45%, speed and/or depth of inspiration 44%, and no postinhalation breath-hold in the 5-10 second range 46%     --breath-activated MDIs: problems with full expiration in 32%, ​speed and/or ...

sometimes it is nice to have a study reaffirming one of the (many) obstacles to delivering high-quality medical care, minimizing medication errors.  The annals of internal medicine just had a study confirming the high rate of errors associated with prescribing generic drugs with ever-changing colors, sizes, shapes...  (see  medication errors with generics ann intern med 2014  in dropbox, or doi:10.7326/M13-2381).  the issue here, which i see almost on a daily basis, is that the patient goes to the pharmacy, gets a refill on a medication, sees it looks totally different from their prior pill, stops taking it because of fear that the new pill was given in error, then comes to me (and i often have to take the time from a busy primary care session to call the pharmacy to make sure it in fact was not an error). obviously, this takes a lot of time, creates angst in the patient, and poses a risk of adverse events by patients not taking their needed medicatio...

Medication adherence issues are one of the most pervasive primary care conundra (?plural for conundrum). i must admit that i always cringe a bit whenever i write for liquid meds for kids, hoping that the pharmacist can appropriately explain how to take the meds and give the appropriate measuring device. (there are other types of educational issues gone awry, evidenced by parents instilling the oral liquid antibiotics directly into the ear, or people taking suppositories by mouth....). so, in this light, there was a study done in new york assessing medication errors and the potential utility of "advanced counseling" in decreasing these errors (see  medical errors liq meds kids acadpeds2014  in dropbox, or  DOI: 10.1016/j.acap.2014.01.003). background: several studies have found that 40% of caregivers make errors in giving kids liquid meds. more if low levels of health literacy, or limited english proficiency. the language used in the instructions can also be conf...